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What Is Coinsurance?

Having a health plan that requires you to pay a coinsurance, or percentage participation, rate means that you’ll essentially be splitting the cost of your healthcare with your insurance carrier.

For instance, if your health plan has an 80/20 co-insurance rate, (coinsurance rates of 70/30 90/10, and flat rates of $5.00 to $20.00 per doctor’s office visit are also common) your insurance plan pays for 80% of your eligible medical expenses and you’re responsible for the remaining 20%.

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To compensate for the possibility that a catastrophic medical loss could cause you severe financial distress, many major health insurance carries include what’s known as a “coinsurance cap,” or stop-loss limit in their plans. The provision sets limits on your potential out-of-pocket costs per year. Such caps generally range from $2,000.00 to $3,000.00, depending on your plan, but limits as low as $1,000.00 are not unheard of.

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